HEADACHE AND FACIAL PAIN: DRUGS FOR MODERATE-TO-SEVERE MIGRAINE

How are ergot alkaloids taken?

Ergotamine can be taken under the tongue, by mouth in combination with caffeine, and as a suppository. Do not use this drug more often or in higher doses than your physician recommends. Ergotamine should not be taken more than two days a week, and it should be taken at least five days apart. Overuse can lead to more headaches. Dihydroergotamine is given as an intravenous or intramuscular injection for emergency treatment of migraine and also has been recently approved as a nasal spray.

What are the possible side effects?

Side effects of this medication may include:

· Nausea or vomiting

· Diarrhea

· Dizziness

· Leg cramps

· Chest discomfort

When should I call my physician?

Call your physician immediately if you experience confusion or anxiety; vision changes; chest pain; increased blood pressure; arm, leg, foot or back pain; or cold or blistered hands or feet.

Also, tell your physician if your migraines became more frequent or intense since you started taking the drug or if it no longer works as well as it did at first. Do not try to make the drug work better by increasing the dose.

Are there drugs I shouldn't take with ergot alkoids?

If you also are receiving injectable epinephrine or other ergot drugs, your physician may need to adjust your dosage. If you are a smoker, refrain from smoking while taking this medication. Do not take ergot alkaloids and triptans within 24 hours of each other.

How are triptans taken?

The triptans (which includes the four drugs listed above) are relatively new drugs developed to treat migraine headaches. These drugs relieve pain and associated migraine symptoms. Naratriptan, rizatriptan and zolmitriptan are available as tablets. Sumatriptan can be taken orally as tablets, by injection (your physician will teach you to give it to yourself) or by nasal spray. These drugs should be taken as soon as head pain begins. The tablets usually take about one hour to two hours to become effective. With the injectable form of sumatriptan, relief usually occurs within 30 minutes. The nasal spray has an onset of action intermediate between the tablet and injection.

If your migraine symptoms improve initially but come back, you may repeat the oral dose of naratriptan after four hours, or the dose of rizatriptan, sumatriptan and zolmitriptan after two hours. If you used the injectable form of sumatriptan and migraine symptoms return, a second injection may be taken after one hour. The dose of sumatriptan nasal spray may be repeated once after two hours. However, for a given migraine attack, if your symptoms do not improve after taking the initial dose of either a tablet or injection, a second dose is unlikely to provide any benefit.

What are the possible side effects?

Some people experience side effects, including:

· Burning or redness at injection site

· Warmth and tingling feeling

· Dizziness

· Drowsiness

· Muscle aches

· Nausea or vomiting

· Feeling of chest or throat tightness

These side effects usually occur less frequently with the oral preparation.

When should I call my physician?

Call your physician immediately if you develop shortness of breath, severe chest pain, sudden or severe abdominal pain, wheezing, facial swelling or other disabling symptoms. In addition, notify your physician if you have used your medication for three separate headaches without obtaining relief. Finally, contact your physician if your headaches get worse, or occur more often, than before you started using your medication.

It is very important to tell your physician if you take other prescription or nonprescription medications for migraine headaches, such as monoamine oxidase (MAO) inhibitors, ergotamine, dihydroergotamine or methysergide. Ask your physician for instructions about taking rizatriptan if you are now taking propranolol. Your physician may want to change the dosage or take other precautions to avoid unwanted interactions between the triptan medications and other medicines. In addition, your physician needs to know if you smoke tobacco. Always tell your physician if you are taking any other medications.

What does combining these drugs do?

Isometheptene constricts, or narrows, inflamed blood vessels in the head; acetaminophen relieves pain; and dichloralphenazone helps you relax.

How is this medication taken?

This medication is taken in capsule form. Take it only as directed by your physician, and do not take it every day for several days in a row. Avoid regular use. Overuse of headache medications can reduce their effectiveness. As with most other headache remedies, this combination is most effective when taken as soon as you are sure that a migraine is on the way.

What are the possible side effects?

Some people feel drowsy after taking this medication.

When should I call my physician?

Call your physician if the medication no longer works as well as it did at first or if your headaches are occurring more often. Do not try to make the drug work better by increasing the dose. Also, call your physician if you feel unusually tired or weak after using this medication.

Are there drugs I shouldn't take with this medication?

Tell your physician if you are taking any other drugs - prescription or over-the-counter - that contain acetaminophen. Do not drink alcoholic beverages or use decongestants while taking this drug. Always tell your physician if you are taking any other medications.